TY - JOUR
T1 - Factors associated with damage accrual in patients with systemic lupus erythematosus
T2 - Results from the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort
AU - Bruce, Ian N.
AU - O'Keeffe, Aidan G.
AU - Farewell, Vern
AU - Hanly, John G.
AU - Manzi, Susan
AU - Su, Li
AU - Gladman, Dafna D.
AU - Bae, Sang Cheol
AU - Sanchez-Guerrero, Jorge
AU - Romero-Diaz, Juanita
AU - Gordon, Caroline
AU - Wallace, Daniel J.
AU - Clarke, Ann E.
AU - Bernatsky, Sasha
AU - Ginzler, Ellen M.
AU - Isenberg, David A.
AU - Rahman, Anisur
AU - Merrill, Joan T.
AU - Alarcón, Graciela S.
AU - Fessler, Barri J.
AU - Fortin, Paul R.
AU - Petri, Michelle
AU - Steinsson, Kristjan
AU - Dooley, Mary Anne
AU - Khamashta, Munther A.
AU - Ramsey-Goldman, Rosalind
AU - Zoma, Asad A.
AU - Sturfelt, Gunnar K.
AU - Nived, Ola
AU - Aranow, Cynthia
AU - Mackay, Meggan
AU - Ramos-Casals, Manuel
AU - Van Vollenhoven, Ronald F.
AU - Kalunian, Kenneth C.
AU - Ruiz-Irastorza, Guillermo
AU - Lim, Sam
AU - Kamen, Diane L.
AU - Peschken, Christine A.
AU - Inanc, Murat
AU - Urowitz, Murray B.
PY - 2015/9/1
Y1 - 2015/9/1
N2 - Background and aims: We studied damage accrual and factors determining development and progression of damage in an international cohort of systemic lupus erythematosus (SLE) patients. Methods: The Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort recruited patients within 15 months of developing four or more 1997 American College of Rheumatology (ACR) criteria for SLE; the SLICC/ACR damage index (SDI) was measured annually. We assessed relative rates of transition using maximum likelihood estimation in a multistate model. The Kaplan-Meier method estimated the probabilities for time to first increase in SDI score and Cox regression analysis was used to assess mortality. Results: We recruited 1722 patients; mean (SD) age 35.0 (13.4) years at cohort entry. Patients with damage at enrolment were more likely to have further worsening of SDI (SDI 0 vs ≥1; p<0.001). Age, USA African race/ethnicity, SLEDAI-2K score, steroid use and hypertension were associated with transition from no damage to damage, and increase(s) in pre-existing damage. Male gender (relative transition rates (95% CI) 1.48 (1.06 to 2.08)) and USA Caucasian race/ethnicity (1.63 (1.08 to 2.47)) were associated with SDI 0 to ≥1 transitions; Asian race/ethnicity patients had lower rates of new damage (0.60 (0.39 to 0.93)). Antimalarial use was associated with lower rates of increases in pre-existing damage (0.63 (0.44 to 0.89)). Damage was associated with future mortality (HR (95% CI) 1.46 (1.18 to 1.81) per SDI point). Conclusions: Damage in SLE predicts future damage accrual and mortality. We identified several potentially modifiable risk factors for damage accrual; an integrated strategy to address these may improve long-term outcomes.
AB - Background and aims: We studied damage accrual and factors determining development and progression of damage in an international cohort of systemic lupus erythematosus (SLE) patients. Methods: The Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort recruited patients within 15 months of developing four or more 1997 American College of Rheumatology (ACR) criteria for SLE; the SLICC/ACR damage index (SDI) was measured annually. We assessed relative rates of transition using maximum likelihood estimation in a multistate model. The Kaplan-Meier method estimated the probabilities for time to first increase in SDI score and Cox regression analysis was used to assess mortality. Results: We recruited 1722 patients; mean (SD) age 35.0 (13.4) years at cohort entry. Patients with damage at enrolment were more likely to have further worsening of SDI (SDI 0 vs ≥1; p<0.001). Age, USA African race/ethnicity, SLEDAI-2K score, steroid use and hypertension were associated with transition from no damage to damage, and increase(s) in pre-existing damage. Male gender (relative transition rates (95% CI) 1.48 (1.06 to 2.08)) and USA Caucasian race/ethnicity (1.63 (1.08 to 2.47)) were associated with SDI 0 to ≥1 transitions; Asian race/ethnicity patients had lower rates of new damage (0.60 (0.39 to 0.93)). Antimalarial use was associated with lower rates of increases in pre-existing damage (0.63 (0.44 to 0.89)). Damage was associated with future mortality (HR (95% CI) 1.46 (1.18 to 1.81) per SDI point). Conclusions: Damage in SLE predicts future damage accrual and mortality. We identified several potentially modifiable risk factors for damage accrual; an integrated strategy to address these may improve long-term outcomes.
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U2 - 10.1136/annrheumdis-2013-205171
DO - 10.1136/annrheumdis-2013-205171
M3 - Article
C2 - 24834926
AN - SCOPUS:84924190291
SN - 0003-4967
VL - 74
SP - 1706
EP - 1713
JO - Annals of the Rheumatic Diseases
JF - Annals of the Rheumatic Diseases
IS - 9
ER -